Author Archives: Jason Schwartz

About Jason Schwartz

Jason Schwartz, LMSW, ACSW, CADC, CCS, is the Clinical Director of Dawn Farm, overseeing treatment services for its two residential treatment sites, sub-acute detox, outpatient treatment services & detention-based juvenile treatment program. Jason is also an adjunct faculty at Eastern Michigan University’s School of Social Work and School of Leadership and Counseling. Jason blogs at www.addictionrecoverynews.com and has been published in Addiction Professional magazine and in a monograph Recovery-oriented Supervision with the Addiction Technology Transfer Center. Jason serves on the advisory boards of Eastern Michigan University’s School of Social Work and School of Leadership and Counseling. Jason also serves as a board member for the Livonia Save Our Youth Task Force, a substance abuse prevention coalition in his home community.

The Lancet and drug harms: missing the bigger picture – TBS

Values IcebergA Throw Back Sunday post from 2007 on values and evaluating drug harms.

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The Transform Drug Policy Foundation offers a response to the recent Lancet article that ranked drugs by harm. The writer suggest that the article is flawed in two important ways. First he argues that it fails to consider harms caused by the illegal status of the drug. Second, he says that the nature of the paper lends itself to criminalization of the drugs judged to be more harmful.

I’ll use this as an opportunity share an opinion I didn’t share in my original post–it’s impossible to separate values from these kinds of decisions. Values influence which harms are identified, how those harms are ranked, who’s opinion is sought, the intended use influences the design, etc.

UPDATE: I received the following comment from a reader:

“Values influence which harms are identified”. Yes that is a description of what happens at present but is shouldn’t be a prescription for what should happen. If we are to base drug classification on scientific evidence then the aim should be to get as close to objectivity as possible.

Let me clarify. In an ideal world I’d agree with the comment, we could objectively quantify harms and know that there is one set of facts for us to operate from. My judgment is that this is fantasy. For example, purportedly objective American harm reduction discussions tend to very heavily emphasize HIV/AIDS. Why? Because the early American harm reduction advocates were HIV/AIDS advocates.

Other tough questions:

  • Should growing up with an addicted parent be considered a harm? Beyond child protective service cases? If yes, how should this be quantified? If not, why?
  • How about the emotional pain experienced by other family members? If the answer is yes, how should these be weighted relative to the harms caused to children?
  • Should the malaise cast over communities be considered a harm? If one looks at certain communities, American Indian reservations for example, the despair due to alcohol (a legal drug) goes well beyond unemployment. Should the pall addiction can cast over an affected community be considered?
  • Should harms to non-users be weighted more heavily? Based on the belief that the user is exercising personal liberty and assumes risks in doing so?
  • When it comes to making harm reduction policy decisions, one harm reduction strategy can reduce harm to one population and increase risk of harm for another.

Don’t get me wrong, I’m glad this study was done and I look forward to more studies like it. I’m just convinced that values can’t honestly be eliminated from the equation. It might be helpful to integrate scientific evidence and a discussion the values like liberty, safety, etc.

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We are sane, sober and responsible

poster-sane-sober

Bill White just posted on a cycle that entrenches stigma within some professions.

“There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover.  The success stories are not visible in their daily professional lives.  We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us.  We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been.  We need to find a way to tell all of them that today, we are sane and sober and have taken responsibility for our own lives.  We need to tell them to be hopeful, that RECOVERY LIVES!  Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery.”

 

 

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Sentences to ponder

wpid-wp-1406109969456.jpegRegardless of the reason one has for ending replacement therapy, making the choice presents a whole new set of challenges. Suboxone is a hard drug to kick. The medication’s long half-life combined with its tight adhesion to opiate receptors makes tapering particularly difficult. From anecdotal reports, the least disruptive way to achieve a Suboxone-free life is to cut down the amount used very slowly week by week until titration is complete.

This scenario is complicated by two facts:

  • The lowest strength Suboxone comes in is 2 mg. (”Jumping” from a 2 mg dose can be a drawn out and debilitating process that takes months to recover from);
  • RBP warns against cutting Suboxone strips into smaller amounts, and maintains that the medication is not equally distributed in the preparation.

Source: Dawn Roberts 

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Stigma and the other

This article has been on my mind, but I haven’t gotten around to posting anything on it. So, for today’s throw back Sunday post, I decided to use a related post.

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Dirk Hansen included this quote in a post on stigma:

“Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”–Susan Sontag, Illness as Metaphor

It brought to mind this quote from Bill White:

How alcohol and other drug problems are constructed are not merely a theoretical issue debated by academics. Whether we define alcoholism as a sin, a crime, a disease, a social problem, or a product of economic deprivation determines whether this society assigns that problem to the care of the priest, police officer, doctor, addiction counselor, social worker, urban planner, or community activist. The model chosen will determine the fate of untold numbers of alcoholics and addicts and untold numbers of social institutions and professional careers.

It’s been on my mind because of this post in the Guardian:

The most miserable aspect of Labour’s methadone policies is that they encouraged people to believe that in switching from illegal drugs to methadone, they have become “clean”. This is a delusion. The most defeatist aspect is that the policies foster the idea that drug addiction is virtually impossible to overcome. Another delusion. . . . I’m not in favour of removing medical crutches that make addicts less of a threat (and I’d advise Cameron to think twice before doing it). But I’m not in favour of leading addicts to believe that they are not capable of doing any better by themselves.

Her use of the word “clean” really bothers me and it’s stuck with me all week. I’m not one to get too hung up on language and I often fear that recovery advocacy movements will hurt themselves by focusing on things like language and adopt a victim position that does little to advance the cause. However, the insinuations lurking in her quotation marks and calling it a delusion stirred very protective feelings toward these methadone clients. In the final sentence, her choice of the words, “by themselves” raises suspicions. Is she implying that they just need to pull themselves up by their bootstraps?

I suspect that the writer and I share a lot of common ground on policy positions (as they relate to methadone) and I agree with her concerns about the pessimistic message sent by methadone programs and policies, but I’m not sure I want her as an ally. I hate to sound cynical and tribal, but I often struggle with the influence of non-addicts in policy and the development of services for addicts.

tumblr_static_bfowdz4y4vwcgkgog0w84so80That sentiment brings to mind this Malcolm X story:

Several times in his autobiography, Malcolm X brings up the encounter he had with “one little blonde co-ed” who stepped in, then out, of his life not long after hearing him speak at her New England college. “I’d never seen anyone I ever spoke before more affected than this little white girl,” he wrote. So greatly did this speech affect the young woman that she actually flew to New York and tracked Malcolm down inside a Muslim restaurant he frequented in Harlem. “Her clothes, her carriage, her accent,” he wrote, “all showed Deep South breeding and money.” After introducing herself, she confronted Malcolm and his associates with this question: “Don’t you believe there are any good white people?” He said to her: “People’s deeds I believe in, Miss, not their words.”

She then exclaimed: “What can I do?” Malcolm said: “Nothing.” A moment later she burst into tears, ran out and along Lenox Avenue, and disappeared by taxi into the world.

I can relate to his sentiment that the most helpful thing others can do is leave us alone. (“Other” can be a pretty ugly word, no?) Then, when I’m a little less emotional, I’m left to consider my own cognitive biases and creeping certitude. I have to think about the contributions of people like Dr. Silkworth, Sister Ignatia, George Vaillant, A. Thomas McLellan, etc.

Malcolm X had a similar experience to this too:

In a later chapter, he wrote: “I regret that I told her she could do ‘nothing.’ I wish now that I knew her name, or where I could telephone her, and tell her what I tell white people now when they present themselves as being sincere, and ask me, one way or another, the same thing that she asked.”

Alex Haley, in the autobiography’s epilogue (Malcolm X had since been assassinated), recounted a statement Malcolm made to Gordon Parks that revealed how affected he was by his encounter with the blonde coed: “Well, I’ve lived to regret that incident. In many parts of the African continent I saw white students helping black people. Something like this kills a lot of argument. . . . I guess a man’s entitled to make a fool of himself if he’s ready to pay the cost. It cost me twelve years.”

Malcolm X realized, too late, that there was plenty this “little blonde coed” could have done, that his response to her was inconsistent with what he, his associates, and his followers wanted to accomplish.

Bill White wrote about the things that have allowed practitioners to avoid the cultural traps in working with addicts:

Four things have allowed addiction treatment practitioners to shun the cultural contempt with which alcoholics and addicts have long been held: 1) personal experiences of recovery and/or relationships with people in sustained recovery, 2) addiction-specific professional education, 3) the capacity to enter into relationships with alcoholics and addicts from a position of moral equality and emotional authenticity (willingness to experience a “kinship of common suffering” regardless of recovery status), and 4) clinical supervision by those possessing specialized knowledge about addiction, treatment and recovery processes. We must make sure that these qualities and conditions are not lost in the rush to integrate addiction treatment and other service systems.

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Sentences to ponder

by karola riegler photography

by karola riegler photography

“According to RBP’s 2013 annual report, Suboxone had sales of $1.2 billion. It is ranked at #39 of the top 100 drugs prescribed in the U.S., placing it above Viagra, Adderall and (generic) hydrocodone. To give this some context, Suboxone revenue is three times that of Super Bowl advertiser/provocateur Go Daddy, and dwarfs brands including Urban Outfitters and Ameritrade. In the U.S. more revenue was generated by Suboxone sales than the entire digital music download business.” –Dawn Roberts

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Students shouldn’t have to sacrifice school for recovery, or recovery for school

Source: Detroit Free Press

Source: Detroit Free Press

This story of a recent University of Michigan student who died while combining Adderall and alcohol touches upon a recent theme in this blog.

Six weeks ago, her son collapsed after snorting ground-up Adderall and chasing it with enough alcohol to stop his heart.

Adderall, if you don’t know, is a prescription drug used to combat attention deficit disorder. Yet among college students, it’s prized for so much more, notably its euphoric high, speed-like jolt and, most deviously, its ability to trick the body during alcohol consumption, so that you can binge, and then binge some more.

. . .

He just wanted to drink on the weekend, ease back on the throttle a bit as he adjusted to his new work life, to adult life — he’d taken a job in sales in Chicago. The problem was the method, one he’d learned on campus, as so many thousands do.

Yes, Julie Buckner knows her son made a mistake. She also admits that she worried when her son joined a fraternity. As a college graduate, she remembers alcohol on campus — she went to U-M.

Then she attended Saturday’s U-M game against Appalachian State. What she saw scared her.

“It’s on a different level now,” she said of the drinking. “What my son did isn’t out of the norm of what’s going on in campuses. And it’s gotta stop.”

This story comes on the heels of a recent uproar about Arizona State University banning drinking games and beer bongs at tailgate parties before football games.

This ASU policy was recently discussed on sports radio with hours of ranting about other schools that have attempted to impose restrictions and that these restrictions quash the fun of tailgating and destroy tradition.

To me, these stories offer an example of cultures of addiction (and various tribes within them) being alive and well on college campuses. (One could argue whether this is really a culture of addiction, because most of the participants are not addicted. However, for the our purposes here, Bill White defined a culture of addiction as “an informal social network in which group norms promote excessive drug use.”)

931213_466395796774090_1850611531_nIn a recent discussion, I observed that some areas might be discussed as “recovery deserts” in they same way we talk about some regions as being “food deserts“. As someone who got sober on a Big 10 college campus, I can tell you that it was a recovery desert. Recovery may have existed in the campus community but, if it did, it was invisible and marginalized by the campus norms around drinking and its status as a celebrated drug on campuses.

This leads me back to the matter of recovery spaces, which leads me to the University of Michigan Collegiate Recovery Program. We’re not talking about creating a bubble for recovering students or judging everyone else on campus. In this vast university, there’s a little office that’s the place to go to learn about recovery, get some help, hang out, make sober plans with other sober people, learn to stay sober in a recovery-hostile environment and support each other. 

This video says more than I can say about its importance. (And, it’s NOT phony. I know these people. They had serious problems. They are all doing REALLY well and pursuing their dreams.)

I don’t know whether Josh Levine was an alcoholic. His brother says he wasn’t and I have no reason to question that. But, if he was, and tried to quit, wouldn’t a visible recovery space like this be a very good thing?

U of M’s Collegiate Recovery Program is in its infancy. I hope it continues to grow and thrive. I wish something like it existed when I got sober. And, I wonder how many lost friends might have attempted recovery or been more successful with their recovery is something like this existed back then.

Related posts here.

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The power of recovery

dd_botticelli_headshotThe Washington Post recently ran a story about the acting drug czar, who happens to be one of us.

The nation’s acting drug czar has a substance-abuse problem.

Botticelli, 56, is an alcoholic who has been sober for a quarter-century. He quit drinking after a series of events, including waking up handcuffed to a hospital bed after a drunken-driving accident and a financial collapse that left him facing eviction.

Decades later, he is tasked with spearheading the Obama administration’s drug policy, which is largely predicated on the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system.

. . .

Hours later, Botticelli stood outside the church where his recovery started and marveled at how he got from there to the White House.

“When I first came here, all I wanted to do was not drink and have my problems go away,” he said, choking up. “I’m standing here 25 years later, working at the White House. And if you had asked me 25 years ago when I came to my first meeting here if that was a possibility, I would’ve said you’re crazy. But I think it just demonstrates what the power of recovery is.”

Previous post: How the hell did I get here?

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